Table 4 provides descriptive data on the socioeconomic status of health center patients. The table is included in both the Universal Report and the Grant Reports.

 

For the Universal Report , include as patients all individuals receiving at least one face-to-face encounter for services within the scope of any of the programs covered by UDS. The Grant Reports include only individuals who received at least one face-to-face encounter that was within the scope of the program in question. Patients are to be reported only once per section in each report filed.

 

NOTE : The sum of Table 3A, Line39, Column A + B (total patients by age and gender) must equal Table 4, Line 6 (patients by income) and Line 12, Column A + B (patients by insurance status.) The sum of Table 3A, Lines 1-20, Columns A + B must equal Table 4, Line 12, Column A. Similarly, total patients reported on the Grant Reports on Tables 3A, 3B and 4 must be equal.

 

Income as Percent of Poverty Level, Lines 1 - 6

 

Grantees are expected to collect income data on all patients, but are not required to collect this information more frequently than once during the year. If income information is updated during the year, report the most current information available. Patients for whom the information was not collected within the last year must be reported on line 5 as unknown. Do not attempt to allocate patients with unknown income. Knowing that a patient is homeless or a migrant or on Medicaid is not adequate to classify that patient as having an income below the poverty level.

 

Income is defined in ranges relative to the Federal poverty guidelines (e.g., < 100 percentage of the federal poverty level). In determining a patient's income relative to the poverty level, grantees should use official poverty line guidelines defined and revised annually. The official Poverty Guidelines are published in the Federal Register in February or March of each year. (Available at http://aspe.hhs.gov/poverty/06poverty.shtml )

 

Every patient reported on Table 3A must be reported once (and only once) on lines 1 through 5. The sum of Table 3A, Line39, Column A + B (total patients by age and gender) must equal Table 4, Line 6 (patients by income). The same is true for Grant Reports.

 

Principal Third Party Insurance Source, Lines 7 - 12

 

This portion of the table provides data on patients by principal source of insurance for primary medical care services. (Other forms of insurance, such as dental or vision coverage, are not reported.) Patients are divided into 2 age groups (Column A) 0 - 19 and (Column B) age 20+. Primary patient medical insurance is divided into six types as follows:

 

•  S-CHIP (Line 8b or 10b) - The State Child Health Insurance Program (also known as S-CHIP) provides primary health care coverage for children and, on a state by state basis, others - especially parents of these children. CHIP coverage can be provided through the state's Medicaid program and/or through contracts with private insurance plans. In some states that make use of Medicaid, it is difficult to distinguish between regular Medicaid and CHIP-Medicaid. In other states the distinction is readily apparent (e.g., they may have different cards). Where it is not obvious, CHIP may often still be identifiable from a "plan" code or some other embedded code in the membership number. This may also vary from county to county within a state. Obtain information from the state and/or county on their coding practice. If there is no way to distinguish between them, classify all covered patients as "regular" Medicaid. In those states where CHIP is contracted through a private third party payor, participants are to be classified as "other public-CHIP" (Line 10b) rnot as private.

•  Medicaid (Line 8a, 8b and 8) - State-run programs operating under the guidelines of Titles XIX (and XXI as appropriate) of the Social Security Act. Medicaid includes programs called by State-specific names (e.g., California 's Medi-Cal program). In some states, the State Children's Health Insurance Program (S-CHIP) is also included in the Medicaid program - see above. While Medicaid coverage is generally funded by Federal and State funds, some states also have "State-only" programs covering individuals ineligible for Federal matching funds (e.g., general assistance recipients) and these individuals are also included on Lines 8a, 8b and 8. NOTE: Individuals who are enrolled in Medicaid but receive services through a private managed care plan that contracts with the State Medicaid agency should be reported as "Medicaid", not as privately insured.

•  Medicare (Line 9) - Federal insurance program for the aged, blind and disabled (Title XVIII of the Social Security Act).

•  Other Public Insurance (Line 10a) -State and/or local government programs, such as Washington's Basic Health Plan or Massachusetts' Commonwealth plan, providing a broad set of benefits for eligible individuals. Do not include uninsured individuals whose visit may be covered by a public source with limited benefits such as the Early Prevention, Screening, Detection and Treatment (EPSDT) program or the Breast and Cervical Cancer Control Program, (BCCCP), etc. ALSO DO NOT INCLUDE persons covered by workers' compensation, as this is not health insurance for the patient, it is liability insurance for the employer.

•  Other Public (S-CHIP) (Line 10-b) - S-CHIP programs which are run through the private sector, often through HMOs, where the coverage appears to be a private insurance plan (such as Blue Cross / Blue Shield) but is funded through S-CHIP.

 

•  Private Insurance (Line 11) - Health insurance provided by commercial and non-profit companies. Individuals may obtain insurance through employers or on their own. Private insurance includes insurance purchased for public employees or retirees such as Tricare, Trigon, Veterans Administration, the Federal Employees Program, etc.

 

One additional categories is reported on Table 4 for patients who are uninsured (line 7).

 

Every patient reported on Table 3A must be reported once (and only once) on lines 7 through 11. The sum of Table 3A, Line39, Column A + B (total patients by age and gender) must equal Table 4, Line 12 (patients by insurance status.) The same is true for Grant Reports.

 

Specific Instructions for Reporting Patients by Source of Insurance

 

Grantees should report the patient's principal health insurance covering primary medical care , if any, as of the last visit during the reporting period. Principal insurance is defined as the insurance plan/program that the grantee would bill first for services rendered. NOTE : Patients who have both Medicare and Medicaid, would be reported as Medicare patients because Medicare is billed before Medicaid. The exception to the Medicare first rule is the Medicare-enrolled patient who is still working and insured by both an employer-based plan and Medicare. In this case, the principal health insurance is the employer-based plan, which is billed first.

 

Patients for whom no other information is available , whose services are paid for by grant programs, including family planning, BCEDP, immunizations, TB control, as well as patients served in correctional facilities, may be classified as uninsured.

 

Similarly, patients whose services are subsidized through State/local government "indigent care programs" are considered to be uninsured. Examples of state government "indigent care programs" include New Jersey Uncompensated Care Program, NY Public Goods Pool Funding, California 's Expanded Assistance for Primary Care, and Colorado Indigent Care Program.

 

For both Medicaid and Other Public Insurance, the table distinguishes between "regular" enrollees and enrollees in CHIP.

 

Medicaid = Line 8b includes Medicaid-CHIP enrollees only; Line 8a includes all other enrollees; and Line 8 is the sum of 8a + 8b.

 

Other Public = Line 10b includes CHIP enrollees who are covered by a plan other than Medicaid; Line 10a includes all other persons with other public insurance (Grantees are asked to describe the programs so the UDS editor can make sure that the classification of the program as other public is appropriate.); and Line 10 is the sum of 10a + 10b.

 

Selected Patient Characteristics - Lines 13 - 23

Selected patient characteristics ask for a count of persons who are enrolled in or otherwise eligible for participation in one or more of the Bureau's "special population" programs including migrant and seasonal agricultural workers, persons who are homeless and patients of school-based health centers.

 

Migrant or Seasonal Agricultural Workers and their Dependents, Lines 13 - 15

All grantees are required to report on Line 15 the combined total number of patients seen during the reporting period who were either migrant or seasonal agricultural workers or their dependents. Section 330(g) grantees (only!) are asked to provide separate totals for migrant and for seasonal agricultural workers on Lines 13 and 14. For Section 330(g) grantees, Lines 13 + 14 = 15

 

Definitions of migrant and seasonal agricultural workers

 

Migrant Agricultural Workers - Defined by Section 330(g) of the Public Health Service Act, a migrant agricultural worker is an individual whose principal employment is in agriculture on a seasonal basis (as opposed to year-round employment) and who establishes a temporary home for the purposes of such employment . Migrant agricultural workers are usually hired laborers who are paid piecework, hourly or daily wages. The definition includes those individuals who have had such work as their principle source of income within the past 24 months as well as their dependent family members who have also used the center. The dependent family members may or may not move with the worker or establish a temporary home. Note that agricultural workers who leave a community to work elsewhere are equally eligible to be classified as migrant as are those who migrate to a community to work there.

 

Seasonal Agricultural Workers - Seasonal agricultural workers are individuals whose principal employment is in agriculture on a seasonal basis (as opposed to year-round employment) and who do not establish a temporary home for purposes of employment . Seasonal agricultural workers are usually hired laborers who are paid piecework, hourly, or daily wages. The definition includes those individuals who have been so employed within the past 24 months and their dependent family members who have also used the center.

 

For both categories of workers, agriculture is defined as farming of the land in all its branches, including cultivation, tillage, growing, harvesting, preparation, and on-site processing for market or storage. Persons employed in aqua culture, lumbering, poultry processing, cattle ranching, tourism and all other non-farm-related seasonal work are not included.

 

Homeless Patients, Lines 16 - 22

 

All grantees are to report the total number of patients, known to have been homeless at the time of any service provided during the reporting period, on Line 22. Only section 330(h) Homeless Program grantees will provide separate totals for homeless program patients by type of shelter arrangement.

 

•  The shelter arrangement reported is their arrangement as of the first visit during the reporting period.

•  "Street" includes living outdoors, in a car, in an encampment, in makeshift housing/shelter or in other places generally not deemed safe or fit for human occupancy.

•  Persons who spent the prior night incarcerated or in a hospital should be reported based on where they intend to spend the night after their encounter. If they do not know, code as "street".

•  Section 330(h) Homeless Program grantees should report previously homeless patients now housed but still eligible for the program on Line 20, "other".

 

Definition of a homeless patient

 

Homeless patients - Are defined as patients who lack housing (without regard to whether the individual is a member of a family), including individuals whose primary residence during the night is a supervised public or private facility that provides temporary living accommodations, and individuals who reside in transitional housing.

 

school based health center Patients, Line 23

 

All grantees that identified a school based health center as a service delivery site on the UDS Cover Sheet are to report the total number of patients who received primary health care services at the school service delivery sites(s) listed.

 

A school based health center is a health center located on or near school grounds, including pre-school, kindergarten, and primary through secondary schools, that provides on-site comprehensive preventive and primary health services.

Questions and Answers for Table 4

 

•  If information on a patient's income is not known, can we use insurance or eligibility for entitlement services as a proxy?

No. Patients for whom the information was not collected within the last year must be reported on line 5 as unknown. Do not attempt to allocate patients with unknown income. Knowing that a patient is homeless or a migrant or on Medicaid is not adequate to classify that patient as having an income below the poverty level.

 

•  If we do not receive a Health Care for the Homeless, Migrant or School-based grant, do we need to report the total number of special population patients served?

Yes. All grantees, regardless of whether they receive targeted grant funding for special populations, are required to complete Lines 15 (total number of patients known to have been homeless at the time of service), 22 (the total number of patients seen during the reporting period who were either migrant or seasonal agricultural workers or their dependents), and Line 23 (the total number of patients who received primary health care services at the school service delivery location(s) listed.) Grantees who did not receive special population funding are not required to complete Lines 13-14 and 16-21.

 

•  Should the number of patients by income and insurance source equal the total number of unduplicated patients reported on Tables 3A and 3B?

Yes.

 

Reporting Period: January 1, 2007 through December 31, 2007 OMB No. 0915-0193 Expiration Date:

TABLE 4 -

SOCIOECONOMIC CHARACTERISTICS

Characteristic			Number Of Patients (a)
Income As Percent of Poverty Level
1.
2.	101 - 150%
3.	151 - 200%
4.	Over 200%
5.
6.	Total (Sum Lines 1 - 5)
Principal Third Party Insurance Source		0-19 (a)		20 and older (b)
7.	None/ Uninsured
8a.
8b.	S-CHIP Medicaid
8.	Total Medicaid (Line 8a + 8b)
9.	Medicare (Title XVIII)
10a.
10b.	Other Public Insurance S-CHIP
10.	Total Public Insurance (Line 10a+Line 10b)
11.	Private Insurance
12.	Total (Sum Lines 7 + 8 + 9 +10 +11)
Characteristic			Number Of Patients (a)
13.	Migrant (330g grantees only)
14.	Seasonal (330g grantees only)
15.	Total Migrant/Seasonal Agricultural Worker or Dependent (All Grantees Report This Line)
16.	Homeless Shelter (330h grantees only)
17.	Transitional (330h grantees only)
18.	Doubling Up (330h grantees only)
19.	Street (330h grantees only)
20.	Other (330h grantees only)
21.	Unknown (330h grantees only)
22.	Total Homeless (All Grantees Report This Line)
	Total school based health center patients (All Grantees Report This Line)